Playing the game Health, equity and urban planning policy Dr Jennifer Kent Sydney School of Architecture, Design and Planning

:: Healthy Built Environments :: By healthy built environments, we are not referring only to health facilities (for instance hospitals, community health centres, GPs surgeries), although they are important. Our main focus is how the built environment influences people’s personal health. For example whether our streets, neighbourhoods, workplaces, transport and food distribution systems contribute to making people sick or preferably help them lead physically and mentally healthy lives, fulfilling potential and resilient to adversity. We are also interested in ‘health equity’ by which we mean whether all members of society have fair access to the health promoting benefits of built environments.

:: Healthy Built Environments :: A healthy built environment is characterised by a careful mix of people, infrastructure, design and distribution. At the scale of the city, healthy built environments require connectivity through active and public transport infrastructure, dense networks of green and public spaces and a diversity of housing choice. Healthy cities aspire to the strategic location of services and employment in centres close to where people live so that the things people need to be healthy can be accessed easily and safely. They typically discourage over reliance on the private car. At the scale of the neighbourhood, healthy built environments contain intuitive street networks that are safe, and public and open spaces that are responsive to context and well maintained. Healthy neighbourhoods provide infrastructure for community interaction and physical activity, such as playgrounds, public squares, community facilities and parks. They offer a mix of densities and uses, and cater to the needs of different populations. At the scale of the building, healthy built environments are designed to provide protection from harms, including noise and fumes; and extremes of heat and cold. They are well constructed to ensure longevity and resilience. Healthy buildings are open to the streets on which they sit, but also provide spaces of privacy and retreat. At all scales, healthy built environments are planned and managed to be inclusive and responsive to diverse spatial and temporal contexts. Planning for healthy built environments aspires to equity and balance in built, social and economic outcomes.

Actual and projected population growth in Sydney 7.3 million by 2036 Actual and projected population growth in Sydney 2001-2036 Source: ABS 2016 Population (millions) Year

222% increase in crane activity                  222% increase in crane activity Q2, 2013 - Q2, 2016                     (165  239 between Q42015 and Q22016)             

Provide access to healthy food Good planning can…. Get People Active Provide access to healthy food Strengthen Community “Three Domains of Urban Planning for Health and Well-being” Source: Kent, J. L. & Thompson, S. (2014) The Three Domains of Urban Planning for Health and Well-Being, Journal of Planning Literature, 29:3, 239-256.

Good planning can get people physically active by, for example: integrating land use and transport to promote walking and cycling for transport; preserving a variety of open spaces for recreation; designing street networks and infrastructure for walking and cycling for recreation and transport. Get People Active

Good planning can strengthen community by, for example: providing streets and public spaces that are safe, clean and attractive; encouraging residential development that is integrated, yet private; enabling community empowerment through meaningful participation in land use decisions. Strengthen Community

Provide access to healthy food Good planning can get provide access to healthy food by, for example: zoning for small scale shops and supermarkets amongst residential environments; reducing fast-food exposure in the vicinity of school environments; retaining peri-urban agricultural lands as a source of easily accessed healthy food; permitting urban agriculture. Provide access to healthy food

“City planning and population health: a global challenge” Destination accessibility Distribution of employment Demand management Design Density Distance to public transport Diversity Desirability Giles-Corti, B., A. Vernez-Moudon, R. Reis, G. Turrell, A. L. Dannenberg, H. Badland, S. Foster, M. Lowe, J. F. Sallis, M. Stevenson and N. Owen (2016). "City planning and population health: a global challenge." The Lancet 388(10062): 2912-2924.

How can we make healthy built environments reality? domains of doing How can we make healthy built environments reality? noun/verb

Doing Healthy Planning in Australia

“the way something is spread over an area or group” distribution /dIstrI’bju{(e)n/ “the way something is spread over an area or group” noun/verb

Unhealthy distribution = unequal balanced

Distances Between Uses + Relative Location of Destinations Density Distances Between Uses + Relative Location of Destinations …but for more information on this see: Stevenson, M., et al. (2016) Land use, transport, and population health: estimating the health benefits of compact cities. The Lancet, 388 (10062) 2925-2935.

Unhealthy distribution = unequal balanced Unhealthy distribution = unequal  Wider distribution of uses across a whole city is just as important for health as micro design elements $ $$ $$ $$$

Unhealthy distribution = unequal balanced Unhealthy distribution = unequal  Wider distribution of uses across a whole city is just as important for health as micro design elements  Distribution’s impact on human health is as much about the distribution of power and wealth. $ $$ $$ $$$

Unhealthy distribution = unequal balanced Unhealthy distribution = unequal  Wider distribution of uses across a whole city is just as important for health as micro design elements  Distribution’s impact on human health is as much about the distribution of power and wealth.  We need to work within the constraints of the existing neo-liberal planning system and health, as an emotive issue, is well positioned to do that. $ $$ $$ $$$

Working to influence neo-liberal planning systems for health •   Working to influence neo-liberal planning systems for health • Attempts to influence a planning system review should be shaped by that system’s values • Health must align with the agendas of influential actors • Lobbying for health needs to happen both before, during and after a review process Kent, J. L., Harris, P., Sainsbury, P., Baum, F., McCue, P. & Thompson, S. (2017). Influencing Urban Planning Policy: An Exploration from the Perspective of Public Health. Urban Policy and Research, 1-15. Harris, P., Kent, J.L, Sainsbury, P. & Thow, A.M. (2016) Framing Health for Land-Use Planning Legislation: a qualitative descriptive content analysis, Social Science and Medicine, 148, 42-51.

design /dI’z^In = verb and noun noun/verb

Reassessment of problems from different perspectives. design based planning = Reassessment of problems from different perspectives. Working with these different perspectives to provide solutions. noun/verb

The Objective and Perceived Built Environment: What Matters for Happiness?" How does the way the built environment is perceived support subjective wellbeing for 562 households in Sydney? Only the perceived evaluations of built environment characteristics were associated with positive affect. Emphasis for participants was on less tangible and more nebulous concepts (aesthetics, cohesion, perceived walkability). To get healthy built environments "done" we need to keep sight of the colourful but complex pasts and presents imbued within the individual agent A design based approach to collaboration with our communities is one way to do this. Kent, J.L., Ma, L. and Mulley, C. "The Objective and Perceived Built Environment: What Matters for Happiness?" article submitted to the journal Cities and Health May 2017 and currently under review.

diversity diverse people, uses and approaches diversity as a precursor to tension noun/verb /d^I’ve:sIti

  Diverse ways of thinking and resistance to change Attachments to the Private Car in Sydney - Trip substitution analysis - 15 people who could travel to work by public and active modes in the same amount it takes them to drive - Why do they still drive? Kent, J.L. (2014) ‘Driving to save time or saving time to drive? The enduring appeal of the private car’. Transportation Research Part A: Policy and Practice, 65, 103-115. Kent, J.L. (2014). Still Feeling the Car – the role of comfort in sustaining private car use. Mobilities (6) DOI:10.1080/17450101.2014.944400

Jennifer: “Have you ever considered moving closer [to work] Jennifer: “Have you ever considered moving closer [to work]?” Larry: “No, I live where I want to live and I work where the work is. I don't understand people that go "this is where I'll work [and] this is where I'll buy a house" because it might not be the area they want to live in.”  

Jennifer: “So the idea of saving time by using public transport….” Frederick: “I remember, a long time ago, I used to catch the train to work. It was really busy, people always trying to find their way, and people trying to squeeze in, sometimes the door shuts too early. So then I think about taking my car, even if it's about 1 hour, 1 hour 15 minutes, even if it’s longer, I don't care. I think, ‘ah, it's fine’, I have the air conditioning, I listen to a bit of music, best of the 80s, the news from the ABC.”

Unhealthy distribution = unequal balanced Unhealthy distribution = unequal  Wider distribution of uses across a whole city is just as important for health as micro design elements  Distribution’s impact on human health is as much about the distribution of power and wealth.  We need to work within the constraints of the existing neo-liberal planning system and health, as an emotive issue, is well positioned to do that. $ $$ $$ $$$

Unhealthy design = disengaged collaborative  Build and maintain what we know works!  Design led planning and policy making Design enables customisation (to perception and context)

Unhealthy diversity = uniform inclusive Diversity of uses, people, processes and approaches  Diversity as a pre-cursor to tension  Respect for diversity enables An understanding of resistance and respect the resistance of others.

A city unsettled is a city full of opportunity Thank you jennifer A city unsettled is a city full of opportunity Thank you jennifer.kent@sydney.edu.au @jenniferleekent